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Practice problems using new risk assessment and recommendations

 Black man with low HDL
 62 yo

 TC: 140 High-intensity statin

 HDL: 35 therapy recommended

 Systolic BP: 130 Comment: TC is low,

 No HTN meds
but age >60, HDL low
also
 Not diabetic

 Nonsmoker

 Calculated risk: 9.1%

Keaney JF, Curfman GD, Jarcho JA. A pragmatic view of the new cholesterol treatment guidelines. N Engl J Med 2013 Nov 27
 White woman with diabetes
 48 yo

 TC: 180 mg/dL Moderate-intensity statin

 HDL: 55 mg/dL therapy recommended

 Systolic BP: 130 mmHg Comment: Qualifies for

 No HTN meds
therapy d/t DM, but risk is
< 7.5%
 Diabetic

 Nonsmoker

 Calculated risk: 1.8%

Keaney JF, Curfman GD, Jarcho JA. A pragmatic view of the new cholesterol treatment guidelines. N Engl J Med 2013 Nov 27
 White man with high cholesterol
 57 yo

 TC: 255 mg/dL No statin therapy

 HDL: 45 mg/dL recommended

 Systolic BP: 110 mmHg Comment: TC high, but no

 No HTN meds
additional risk factors….

 Not diabetic

 Nonsmoker

 Calculated risk: 7.2%

Keaney JF, Curfman GD, Jarcho JA. A pragmatic view of the new cholesterol treatment guidelines. N Engl J Med 2013 Nov 27
 Black male smoker
 42 yo

 TC: 180 mg/dL No statin therapy

 HDL: 40 mg/dL recommended

 Systolic BP: 130 mmHg Comment: Smokes, but no

 No HTN meds
additional risk factors….

 Not diabetic

 Smoker

 Calculated risk: 6.3%

Keaney JF, Curfman GD, Jarcho JA. A pragmatic view of the new cholesterol treatment guidelines. N Engl J Med 2013 Nov 27
 White male smoker with high cholesterol
 42 yo

 TC: 250 mg/dL High-intensity statin

 HDL: 40 mg/dL therapy recommended

 Systolic BP: 130 mmHg Comment: TC high and

 No HTN meds
patient smokes

 Not diabetic

 Smoker

 Calculated risk: 9.0%

Keaney JF, Curfman GD, Jarcho JA. A pragmatic view of the new cholesterol treatment guidelines. N Engl J Med 2013 Nov 27
 White man with history of statin intolerance

 61 yo

 TC: 200 mg/dL Moderate-intensity statin

 HDL: 35 mg/dL therapy recommended

 Systolic BP: 145 mmHg Comment: Risk >7.5%, but

 Taking HTN meds
has a history of statin
intolerance
 Not diabetic

 Nonsmoker

 Calculated risk: 17%

Keaney JF, Curfman GD, Jarcho JA. A pragmatic view of the new cholesterol treatment guidelines. N Engl J Med 2013 Nov 27
 Elderly black man
 79 yo

 TC: 150 mg/dL Moderate-intensity statin

 HDL: 40 mg/dL therapy recommended

 Systolic BP: 120 mmHg Comment: Risk >7.5%, but

 Not taking HTN meds
is greater than 75 yo

 Not diabetic

 Nonsmoker

 Calculated risk: 13.7%

Keaney JF, Curfman GD, Jarcho JA. A pragmatic view of the new cholesterol treatment guidelines. N Engl J Med 2013 Nov 27
 Black woman taking amiodarone
 54 yo

 TC: 182 mg/dL Moderate-intensity statin

 HDL: 45 mg/dL therapy recommended

 Systolic BP: 135 mmHg Comment: Risk >7.5%, but

 Taking HTN meds
taking amiodarone (CYP
metabolism  DDI
 Not diabetic

 Smoker

 Calculated risk: 12.1%

Keaney JF, Curfman GD, Jarcho JA. A pragmatic view of the new cholesterol treatment guidelines. N Engl J Med 2013 Nov 27
 White female smoker with DM
 50 yo

 TC: 180 mg/dL High-intensity statin

 HDL: 50 mg/dL therapy recommended

 Systolic BP: 135 mmHg Comment: TC and HDL

 Taking HTN meds
WNL, but patient has DM
and HTN and smokes
 Diabetic

 Smoker

 Calculated risk: 9.8%

Keaney JF, Curfman GD, Jarcho JA. A pragmatic view of the new cholesterol treatment guidelines. N Engl J Med 2013 Nov 27
 Black woman in her 60s
 64 yo

 TC: 190 mg/dL No statin therapy

 HDL: 45 mg/dL recommended

 Systolic BP: 125 mmHg Comment: THDL low, but

 Not taking HTN meds
no other risk factors

 Nondiabetic

 Nonsmoker

 Calculated risk: 6.9%

Keaney JF, Curfman GD, Jarcho JA. A pragmatic view of the new cholesterol treatment guidelines. N Engl J Med 2013 Nov 27
 White woman with hyperlipidemia and HTN

 46 yo

 TC: 230 mg/dL No statin therapy

 HDL: 55 mg/dL recommended

 Systolic BP: 150 mmHg Comment: TC high and BP

 Taking HTN meds
not controlled, but no other
risk factors
 Not diabetic

 Nonsmoker

 Calculated risk: 2.0%

Keaney JF, Curfman GD, Jarcho JA. A pragmatic view of the new cholesterol treatment guidelines. N Engl J Med 2013 Nov 27